Effects of intrathecal fentanyl as an adjunct to hyperbaric bupivacaine in spinal anesthesia for elective caesarean section.

Hyperbaric bupivacaine is the most common drug used in spinal anesthesia for caesarean section. The aim of this study was to compare the effects of adding fentanyl to intrathecal bupivacaine on the onset and duration of spinal anesthesia and its effect on mother and neonate. Seventy healthy parturients with singleton pregnancy scheduled for elective cesarean section were randomly allocated to receive subarachnoid block with 0.5% bupivacaine heavy 2.4 ml (Group A) or fentanyl 20 microgram (0.4 ml) added to 0.5% bupivacaine heavy 2 ml (Group B). Blood pressure, heart rate, respiratory rate, oxygen saturation, along with characteristics of spinal block were assessed throughout the surgery and in the postoperative ward until the patient requested for analgesia. It was found that duration of sensory block was prolonged in fentanyl group (p < 0.05). Duration of complete analgesia (97 ± 8.23 minutes vs 153 ± 7 minutes; p value = 0.00) and effective analgesia (134 ± 5.6 minutes vs 164 ± 9; p value = 0.00) were also found to be prolonged in Group B. There was not much difference in the occurrence of side effects in both the groups. Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.

Impact of first aid training in management of snake bite victims in Madi valley.

BACKGROUND: Tropical lowland on Nepal is at full of risk to snake bite. The snake bite mortality is due to lack of awareness about proper management of victims. The study aims to assess the change in the pattern of management of snake bite victims after first aid training. METHODS: A retrospective study was done from October 2007 to October 2008 among 43 snake bite victims in rural Madi valley comprising of 4 village development committees where first aid training was conducted one year before. RESULTS: Only 26% of the snake bite victims approached traditional healer before arriving at the heath facility. The case fatality rate dropped to 22% after venomous snake bite. Pressure Immobilization bandaging and local compression pad immobilization technique was used by 56% who went to the health facility. Mean duration for reaching health facility was 61.51±33.55 minutes. Common places of bite were field 16 (37.2%), Indoor 6 (14%), while sleeping 6 (14%), and yard 6 (14%). Lower extremity bites were 32 (74.4%), upper extremity 8 (18.6%) and head 3 (7%). Bicycle was the commonest mode of transport 22 (51%) followed by ambulance 9(27.9%) and Motorcycle 6 (11%). CONCLUSIONS: First aid training changes the attitude of the people in management of snake bite victims and is one of the effective ways in decreasing mortality. Nationwide campaigning should be done especially at snake bite prone area about the proper first aid technique to improve the awareness level of the general population.

Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block.

This is a prospective, randomized, double blind study to evaluate the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an admixture to bupivacaine in upper extremity surgery. Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups; one group received Tramadol (2 mg/kg) and the other group received Dexamethasone (8 mg) as an admixture to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesics. The mean duration of postoperative analgesia in the Dexamethasone group was 1028.00 minutes while in the tramadol group it was 453.17 minutes We concluded that Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

Comparative study between bupivacaine heavy vs pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section.

OBJECTIVE: To study early hemodynamic changes and duration of postoperative analgesia between two study groups of intrathecal pethidine and bupivacaine heavy in patients undergoing caesarean section. METHODOLOGY: Total number of 60 patients of ASA I and II, undergoing caesarean section were enrolled in the study. All the patients were divided into two groups: Pethidine and Bupivacaine heavy. The dose of pethidine for subarachnoid block was 1mg/kg and in Bupivacaine group 2.2 ml of 0.5% bupivacaine heavy was given intrathecally. Heart rate and blood pressure of all the patients were recorded before subarachnoid block. After giving spinal anesthesia, the heart rate and blood pressure were monitored and recorded in different time intervals. The duration of postoperative analgesia in all patients was recorded in postoperative ward. The APGAR Scores of the babies were recorded in 1 and 5 minutes after delivery. The data were statistically compared using independent sample t-test. CONCLUSION: The hemodynamic parameters (HR & BP) were compared in different time intervals. The difference in heart rate and blood pressure at different time intervals in the two study groups were statistically insignificant as (p > 0.05). The total duration of postoperative analgesia in patients receiving sole intrathecal pethidine was 8 hours and 30 minutes. Where as, in Bupivacaine group the duration was 2 hrs and 36 minutes. This has been found statistically significant (p<0.05).

Comparative study of esmolol and labetalol to attenuate haemodynamic responses after electroconvulsive therapy.

OBJECTIVE: The study was designed to evaluate the hemodynamic effects of Esmolol and labetalol in patients undergoing electroconvulsive therapy. MATERIALS AND METHODS: Ninety patients undergoing electroconvulsive therapy treatment were studied according to randomized, double blind placebo controlled protocol. Ninety patients were divided into three groups with thirty patients in each group. Patients received either Esmolol (1 mg/kg), Labetalol (0.25 mg/kg) or Normal Saline (placebo) intravenously just after induction with propofol. The baseline heart rate and blood pressure were recorded. Hemodynamic parameters before and after drug therapy and after the ECT current application, were recorded at different time intervals. RESULTS: It was found that Esmolol significantly attenuated the degree of tachycardia and hypertension after ECT in comparison with placebo in the first three minutes (p<0.05), whereas the rise in HR and blood pressure was significantly blunted in the labetalol group in comparison to placebo, from three minutes onward till ten minutes. (p<0.05). CONCLUSION: It was concluded that Esmolol is effective in blunting the hemodynamic response after ECT stimulus in the first three minutes after application of the electrical current, whereas Labetalol is effective after five minutes onwards till ten minutes.

Peripartum cardiomyopathy undergoing caesarean section under epidural anaesthesia.

PURPOSE: To report a case of peripartum dilated cardiomyopathy presenting for emergency caesarean section, this was successfully managed with Epidural Anaesthesia. CLINICAL FEATURES: A parturient suffering from idiopathic peripartum cardiomyopathy (E.F. 18%) was brought for an emergency caesarean section. Epidural anaesthesia was performed and 2% Lignocaine with adrenaline total 13 ml was injected into the epidural space. The patient's haemodynamic status was monitored with NIBP, ECG, pulse oximetry. Patient's perioperative course was uneventful. CONCLUSION: In patients suffering from peripartum cardiomyopathy, undergoing caesarean section epidural anaesthesia is an acceptable anaesthetic alternative.

Patterns of leaf conductance and water potential of five Himalayan tree species.

We studied variations in water relations and drought response in five Himalayan tree species (Schima wallichii (DC.) Korth. (chilaune) and Castanopsis indica (Roxb.) Miq. (dhale katus) at an elevation of 1400 m, Quercus lanata Smith (banjh) and Rhododendron arboreum Smith (lali gurans) at 2020 m, and Quercus semecarpifolia Smith (khasru) at 2130 m) at Phulchowki Hill, Kathmandu, Nepal. Soil water potential at 15 (Psi(s15)) and 30 cm (Psi(s30)) depths, tree water potential at predawn (Psi(pd)) and midday (Psi(md)), and leaf conductance during the morning (g(wAM)) and afternoon (g(wPM)) were observed from December 1998 to April 2001, except during the monsoon months. There was significant variation among sites, species and months in Psi(pd), Psi(md), g(wAM) and g(wPM), and among months for all species for Psi(s15). Mean Psi(pd) and Psi(md) were lowest in Q. semecarpifolia (-0.40 and -1.18 MPa, respectively) and highest in S. wallichii (-0.20 and -0.63 MPa, respectively). The minimum Psi value for all species (-0.70 to -1.79 MPa) was observed in March 1999, after 4 months of unusually low rainfall. Some patterns of Psi(pd) were related to phenology and leaf damage. During leafing, Psi(pd) often increased. Mean g(wAM) and g(wPM) were highest in Q. semecarpifolia (172 and 190 mmol m(-2) s(-1), respectively) and lowest in C. indica (78 and 74 mmol m(-2) s(-1), respectively). Soil water potential (Psi) at 15 cm depth correlated with plant Psi in all species, but rarely with g(wAM) and not with g(wPM). Plant Psi declined with increasing elevation, whereas g(w) increased. As Psi(pd) declined, so did maximal g(w), but overall, g(w) was correlated with Psi(pd) only for R. arboreum. Schima wallichii maintained high Psi, with low stomatal conductance, as did Castanopsis indica, except that C. indica had low Psi during dry months. Rhododendron arboreum maintained high Psi(pd) and g(w), despite low soil Psi. Quercus lanata had low g(w) and low Psi(pd) in some months, but showed no correlation between tree Psi and g(w). Quercus semecarpifolia, which grows at the highest elevation, had low soil and plant Psi and high g(w).